212 R.I. Code R. 212-RICR-10-10-1.3

Current through December 3, 2024

Section 212-RICR-10-10-1.3 - Definitions, General Requirements, and Procedures

1.3.1Definitions

A. The following words and terms shall have the assigned meanings throughout this Part unless a specific context clearly indicates otherwise:

1. "Administer" means the direct application of a medication, whether by injection, inhalation, ingestion, or any other means, to the body of an individual by:

a. A licensed and authorized agent under his or her direction, or

b. The individual at the direction and in the presence of the licensed and authorized agent.

2. "Admission" means acceptance into a program or service, after an initial biopsychosocial assessment has been conducted and includes opening a treatment record for the person, orienting him or her to the organization, and assigning his or her treatment to an appropriate staff person or team. Individuals shall be admitted to the organization no later than their third (3^rd) consecutive face-to-face clinical service.

3. "Advanced practice registered nurse" (APRN) means as ascribed in R.I. Gen. Laws § 5-34-3 (1) as the title given to an individual licensed to practice advanced practice registered nursing (as defined in R.I. Gen. Laws § 5-34-3 (2)) within one (1) of the following roles: certified nurse practitioner (CNP) as defined in R.I. Gen. Laws § 5-34-3 (5), certified registered nurse anesthetist (CRNA) as defined in R.I. Gen. Laws Chapter 5-34.2, and certified clinical nurse.

4. "Advocate" means a:

a. Legal guardian, or

b. An individual acting in support of or on behalf of a person in a manner consistent with the interests of the person.

5. "Assessment" means the process of testing, gathering biopsychosocial information, and making a diagnostic judgment to determine an individual's behavioral health status and need for services, conducted by a qualified staff person.

6. "Behavioral health issue" means any of the symptoms that are caused by either a mental illness, substance use disorder or a combination of both.

7. "Behavioral healthcare" means the umbrella term that encompasses all mental health and substance use related assessment, treatment, prevention, and support services.

8. "Behavioral healthcare organization" or "BHO" means a public or private establishment primarily constituted, staffed, and equipped to deliver mental health and/or substance use services to the general public.

9. "Behavioral management" means any intervention or treatment that utilizes positive reinforcement and/or restrictions to help an individual receiving services to develop and/or strengthen recovery-oriented behaviors and to address and correct targeted behaviors.

10. "Behavioral management plan" means an agreement negotiated with the person served, and as appropriate, family member, guardian or advocate, in which mutually acceptable behavioral goals and interventions are specified.

11. "Best practice standards" means principles of care that reflect the type and implementation of service recommended by research, professional literature, and professional experience.

12. "Board" means the Board of Directors of the organization and/or the advisory board of a behavioral healthcare organization that is:

a. A for-profit entity or

b. A not-for-profit entity that is part of a national organization providing services in Rhode Island.

13. "Clinical screening" means the process of gathering demographic and clinical information when an individual is potentially in need of or requests services from a BHO. The screening is conducted to determine the person's level of risk and the type of service needed, as well as the person's eligibility and appropriateness for a particular service.

14. "CMHC" or "CMHO" means a private, non-profit community mental health center or community mental health organization designated by the Director of the Department and licensed as such to ensure services are available through program delivery, local planning, service coordination, and monitoring outcomes within a specified geographical area according to R.I. Gen. Laws Chapter 40.1-8.5 for the Department's priority populations within eight (8) areas according to R.I. Gen. Laws §40.1-5.4 7(3).

15. "Community residence" means a facility that operates twenty-four (24) hours a day to provide room, board, supervision and supportive services to three (3) or more people who have developmental, mental and/or substance related disabilities.

16. "Complaint" means a formal, written request for further review of an unresolved concern or an allegation against a licensed organization or provider regarding an alleged violation of ethical standards, Regulations, or law.

17. "Concern" means an issue that is perceived as interfering with a person receiving adequate treatment.

18. "Co-occurring disorder" means the coexistence of two (2) or more behavioral health conditions, existing simultaneously and often independently of each other.

19. "Courtesy dosing" means the provision of medication to an individual by a licensed Opioid Treatment Program that is not the individual's usual or customary treatment site.

20. "Department" means the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals.

21. "Director" means the Director of the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, his/her agents or assigns.

22. "Dispense" means the preparation, administration, or delivery of a medication pursuant to the lawful order of a licensed healthcare prescriber.

23. "Division of Behavioral Healthcare Services" or "DBH" means the unit within the Department that is responsible for mental health and substance abuse prevention, treatment and recovery support services.

24. "Evidence-based practice" means an intervention or service for which there is strong research demonstrating effectiveness in assisting persons to achieve desired outcomes.

25. "Facility" means the physical site where programs and services are provided and/or overseen, or could be provided, and as defined in R.I. Gen. Laws § 40.1-24-1.

26. "Full-time equivalent" or "FTE" means the number of hours designated by an organization that constitutes a standard work week for that organization.

27. "Health information exchange" or "HIE" means the technical system operated, or to be operated, by the Regional Health Information Organization (RHIO) under State authority allowing for the statewide electronic mobilization of confidential health information, regulated by R.I. Gen. Laws Chapter 5-37.7, and 216-RICR- 10-10-6, Regional Health Information Organization and Health Information Exchange.

28. "Individual" or "Individual served" means a person who receives behavioral healthcare services or is assessed to need behavioral healthcare services based on the results of an initial assessment. The term "person served" shall be synonymous herein with the term "individual."

29. "Informed consent" means the permission given by a person who has the legal capacity to give consent to or to authorize treatment. Such person:

a. Is able to exercise free power of choice without the intervention of any element of force, fraud, deceit, duress, over-reaching, or other form of constraint or coercion; and

b. Has been given sufficient information about the risks and benefits of the proposed treatment or procedure and the elements involved to be able to make a knowledgeable and enlightened decision.

30. "Investigation" means a systematic review and search for facts. It is objective in nature and is intended to identify facts, sequence and chronology of events, active failure(s), latent failure(s) and assessment of risk as pertinent to a specific adverse event. An investigation may be undertaken as a result of a complaint, an adverse event or incident report, or other information that comes to the attention of the Department or the organization.

31. "Licensed independent clinician or practitioner" means any individual who is permitted by law to provide behavioral health services without direction or supervision, within the scope of the individual's license.

32. "Licensed Practical Nurse" or "L.P.N." means an individual who practices "Practical nursing," as defined in R.I. Gen. Laws § 5-34-3(13), which is an integral part of nursing based on a knowledge and skill level commensurate with education. It includes promotion, maintenance, and restoration of health and utilizes standardized procedures leading to predictable outcomes that are in accord with the professional nurse regimen under the direction of a registered nurse. In situations where registered nurses are not employed, the licensed practical nurse functions under the direction of a licensed physician, dentist, podiatrist, or other licensed health care providers authorized by law to prescribe. Each L.P.N. is responsible for the nursing care rendered.

33. "Medical detoxification" means the medical management of the physiological and psychological symptoms of withdrawal from alcohol and/or another drug of misuse that is provided in a hospital or free standing, appropriately-equipped, setting.

34. "Medically supervised withdrawal" (within an Opioid Treatment Program) means a gradual withdrawal of the treatment agent using decreasing doses in such a manner that a zero (0) dose of the treatment agent is achieved over a period of time, as determined by the physician, in conjunction with the person served.

35. "Mental health professional" means, as defined by the Mental Health Law in R.I. Gen. Laws § 40.1-5-2, a psychiatrist, psychologist, clinical social worker, psychiatric nurses, psychiatric mental health nurse (PMH-BC), psychiatric and mental health CNP (PMHNP-BC), adult psychiatric and mental health CNS (PMHCNS), mental health counselor and other such persons, as may be defined by the Director.

36. "Minor/child" means any person less than eighteen (18) years of age who is not emancipated.

37. "Opioid treatment program" or "OTP" means a service that administers or dispenses methadone and other approved medication as maintenance or detoxification treatment to a person dependent on opioids. It provides, when appropriate or necessary, a comprehensive range of medical and rehabilitative services, is approved by the State authority and SAMHSA, and is registered with the Drug Enforcement Administration to use opiate replacement therapy for the treatment of opioid use disorder.

38. "Orientation" means a process to provide initial information about the BHO and its services to persons served and to staff of the organization. For staff, orientation includes an assessment of their competence relative to their job responsibilities and the organization's mission, vision, and values.

39. "Outcome" means the result(s) of the performance or the non-performance of a function or process.

40. "Outpatient detoxification" means the medical management, provided through outpatient services, of the physiological and psychological symptoms of withdrawal from alcohol and/or another drug of abuse, to ensure that medical or psychological complications do not develop.

41. "Person-centered plan" means the written plan that results from a collaborative process between the person served and the service provider that describes the activities and services that will guide the individual's efforts toward recovery and incorporates information collected during the assessment. It is also called the treatment plan.

42. "Physical examination" means an examination by a duly licensed physician, nurse practitioner, or physician assistant that shall include physical evaluation for possible cardiopulmonary, hepatic, neurological, or infectious conditions. It should also include a tuberculin test or chest x-ray unless there is documented evidence of such a test within the previous six (6) months.

43. "Premises" means a tract of land and the buildings thereon where direct services are provided.

44. "Priority population" means individuals eligible for specific services based on criteria set by the Department.

45. "Program" means a planned structured service delivery system structured to provide specific components that are responsive to the needs of the persons served.

46. "Provider" means a person or organization that manages or delivers clinical and/or support services.

47. "Qualified mental health professional" or "QMHP" means a mental health professional who has a minimum of a Master's Degree in a clinical practice, a license as a Registered Nurse, or a license as an Advanced Practice Registered Nurse as defined in §1.3.1(A)(3) of this Part above; and who has a minimum of thirty (30) hours of supervised face-to-face emergency services contact experience as a psychiatric emergency service worker in Rhode Island. Such experience may be gained through employment with a CMHC or a licensed hospital conducting emergency psychiatric assessment for individuals under consideration for admission to a department designated an inpatient mental health facility.

48. "Recovery" means a process of overcoming both physical and psychological symptoms and/or behaviors associated with a mental illness or a dependence on a drug or drugs of abuse.

49. "Registered Nurse" or "R.N." means an individual who practices "professional nursing" pursuant to R.I. Gen. Laws §§ 5-34-3(11) and (14). The practice of professional nursing is a dynamic process of assessment of an individual's health status, identification of healthcare needs, determination of health care goals with the individual and/or family participation, and the development of a plan of nursing care to achieve these goals. Nursing actions, including teaching and counseling, are directed toward the promotion, maintenance, and restoration of health and evaluation of the individual's response to nursing actions and the medical regimen of care. The professional nurse provides care and support of individuals and families during periods of wellness and injury and incorporates where appropriate, the medical plan of care as prescribed by a duly licensed physician, dentist or podiatrist or other licensed healthcare provider authorized by law to prescribe. Each R.N. is directly accountable and responsible to the consumer for the nursing care rendered.

50. "Rehabilitation service" means a service specifically tailored to assist a person to improve physical, psychosocial, and vocational functioning.

51. "Residential services" means a type of service providing twenty-four (24) hour care, treatment, and support in a setting other than a hospital.

52. "Restraint" means restricting the movement of the whole or a portion of a person's body as a means of controlling a person's physical activity to protect the person or others from injury.

a. "Chemical or pharmacological restraint" means medication that is given for the emergency control of behavior when the medication is not standard treatment for the individual's medical or psychiatric condition.

b. "Mechanical restraint" means the use of an approved mechanical device that restricts the freedom of movement or voluntary functioning of a limb or a portion of a person's body as a means to control his or her physical activities.

c. "Physical restraint" means the use of approved physical interventions or "hands on" holds to prevent an individual from moving his or her body to engage in a behavior that places him, her or others at risk of physical harm.

53. "Seclusion" means retention, for any period of time, of an individual alone in a locked room, or a space from which the individual may not freely exit or from which the individual believes he or she may not exit.

54. "Service area" means the geographical area designated by the Director that forms the boundaries within cities and towns for each CMHC.

55. "Services" means the individually planned interventions intended to reduce or ameliorate the symptoms of mental disorders or substance dependence or abuse through treatment, training, rehabilitation, or other supports.

56. "Significant others" means individuals who are important to the person served, as identified by the person served.

57. "Staff" means and includes, but is not limited to, any employee, intern, trainee, or volunteer performing a service or activities for the organization and for meeting the needs of individuals served for which competent performance is expected.

58. "State opioid treatment authority" means the Department and is also used to refer to the individual designated by the Director to serve as a liaison between the Department, the federal government and the organizations who provide services to individuals with opioid use disorder.

59. "Twenty-four/seven" or "24/7" means continually for twenty-four (24) hours per day, seven (7) days per week.

1.3.2General Requirements

A. Any organization licensed or funded by the Department to provide services shall operate in accordance with all applicable local, State and Federal laws, Rules, and Regulations.

B. All hearings and reviews required pursuant to these Rules and Regulations shall be held in accordance with the provisions of R.I. Gen. Laws Chapter 42-35 and the Executive Office of Health and Human Services (EOHHS) Rules and Regulations for Appeal Process and Procedures for EOHHS Agencies and Programs (210-RICR- 10-05-2).

1.3.3Licensing and Statutory Designations

A. No person or governmental unit, acting separately or jointly with any other person or governmental unit, shall establish, conduct, or maintain a facility, program, or organization as defined in this Part without a license, pursuant to R.I. Gen. Laws § 40.1-24-3.

B. An organization that wishes to provide clinical behavioral healthcare services shall apply for a BHO License in accordance with Subchapter 00 Part 1 of this Chapter, Licensed Organizations (212-RICR- 10-00-1).

C. A BHO that is designated by the Director as a CMHC according to R.I. Gen. Laws Chapter 40.1-8.5 shall apply for a BHO/CMHC License.

D. An organization, not designated as a CMHC, that was approved by the Director to provide specialty services traditionally associated with a CMHC prior to the effective date of these Regulations, may apply to provide such services.

212 R.I. Code R. 212-RICR-10-10-1.3

Adopted effective 1/7/2019
Amended effective 12/27/2022
Amended effective 2/13/2023
Amended effective 1/1/2024